Skip to main content
SpringerLink
Log in

Obesity and Chronic Obstructive Pulmonary Disease

  • Chapter
  • First Online:
Obesity and Lung Disease

Part of the book series: Respiratory Medicine ((RM,volume 19))

  • 1515 Accesses

Abstract

COPD and obesity are two heterogeneous chronic conditions with increasing prevalences all over the world. For accurate clinical assessment and disease management, it is important to understand the effects of excessive fat accumulation in patients with concomitant COPD and obesity. In COPD, obesity results in reductions in static lung hyperinflation, irrespective of the severity of airflow limitation. The impact of obesity on exercise capacity in COPD is likely dependent on the type of exercise, with obesity being associated with decreased tolerance to weight-bearing exercise while having beneficial effects on dynamic ventilatory mechanics during weight-supported exercise. Although obese COPD patients have higher levels of systemic inflammation and increased risk of metabolic syndrome, it is currently unknown whether and to what extent adipose tissue dysfunction and insulin resistance contribute to increased cardiovascular risk and extrapulmonary manifestations in COPD. In contrast to early stage COPD, obesity seems to protect against mortality in patients with severe disease. Even though additional studies on the interaction between obesity and COPD are warranted, the current findings suggest that the presence of obesity has implications for interpretation of diagnostic measurements and management of patients with COPD. Future studies need to show the overall effects of nutritional interventions in obese COPD patients and determine the optimal BMI for an obese patient with COPD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532–55.

    Article  PubMed  Google Scholar 

  2. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370(9589):741–50.

    Article  PubMed  Google Scholar 

  3. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet. 1997;349(9064):1498–504.

    Article  PubMed  CAS  Google Scholar 

  4. Loke J, Mahler DA, Man SF, Wiedemann HP, Matthay RA. Exercise impairment in chronic obstructive pulmonary disease. Clin Chest Med. 1984;5(1):121–43.

    PubMed  CAS  Google Scholar 

  5. American Thoracic Society/European Respiratory Society Statement. Skeletal muscle ­dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159(4 Pt 2):S1–40.

    Google Scholar 

  6. Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.

    PubMed  Google Scholar 

  7. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. 2000.

    Google Scholar 

  8. Franssen FM, O’Donnell DE, Goossens GH, Blaak EE, Schols AM. Obesity and the lung: 5. Obesity and COPD. Thorax. 2008;63(12):1110–7.

    Article  PubMed  CAS  Google Scholar 

  9. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(9):972–7.

    Article  PubMed  Google Scholar 

  10. Montes de Oca M, Talamo C, Perez-Padilla R, Jardim JR, Muino A, Lopez MV, et al. Chronic obstructive pulmonary disease and body mass index in five Latin America cities: the PLATINO study. Respir Med. 2008;102(5):642–50.

    Article  PubMed  Google Scholar 

  11. Steuten LM, Creutzberg EC, Vrijhoef HJ, Wouters EF. COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care. Prim Care Respir J. 2006;15(2):84–91.

    Article  PubMed  Google Scholar 

  12. Schokker DF, Visscher TL, Nooyens AC, van Baak MA, Seidell JC. Prevalence of overweight and obesity in the Netherlands. Obes Rev. 2007;8(2):101–8.

    Article  PubMed  CAS  Google Scholar 

  13. Eisner MD, Blanc PD, Sidney S, Yelin EH, Lathon PV, Katz PP, et al. Body composition and functional limitation in COPD. Respir Res. 2007;8:7.

    Article  PubMed  Google Scholar 

  14. Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol. 2010;108(1):206–11.

    Article  PubMed  Google Scholar 

  15. Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109(1):144–51.

    Article  PubMed  CAS  Google Scholar 

  16. Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med. 2002;162(13):1477–81.

    Article  PubMed  Google Scholar 

  17. Collard P, Wilputte JY, Aubert G, Rodenstein DO, Frans A. The single-breath diffusing capacity for carbon monoxide in obstructive sleep apnea and obesity. Chest. 1996;110(5):1189–93.

    Article  PubMed  CAS  Google Scholar 

  18. O’Donnell DE. Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2006;3(2):180–4.

    Article  PubMed  Google Scholar 

  19. Ora J, Laveneziana P, Ofir D, Deesomchok A, Webb KA, O’Donnell DE. Combined effects of obesity and COPD on dyspnea and exercise tolerance. Am J Respir Crit Care Med. 2009;180:964–71.

    PubMed  Google Scholar 

  20. O’Donnell DE, Deesomchok A, Lam YM, Guenette JA, Amornputtisathaporn N, Forkert L, et al. Effects of body mass index on static lung volumes in patients with airway obstruction. Chest. 2011;140(2):461–8.

    Article  PubMed  Google Scholar 

  21. Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.

    PubMed  CAS  Google Scholar 

  22. Lean ME, Han TS, Seidell JC. Impairment of health and quality of life using new US federal guidelines for the identification of obesity. Arch Intern Med. 1999;159(8):837–43.

    Article  PubMed  CAS  Google Scholar 

  23. Babb TG, Ranasinghe KG, Comeau LA, Semon TL, Schwartz B. Dyspnea on obese women: association with an increased oxygen cost of breathing. Am J Respir Crit Care Med. 2008;178(2):116–23.

    Article  PubMed  Google Scholar 

  24. Ofir D, Laveneziana P, Webb KA, O’Donnell DE. Ventilatory and perceptual responses to cycle exercise in obese women. J Appl Physiol. 2007;102(6):2217–26.

    Article  PubMed  Google Scholar 

  25. Hughes RL, Katz H, Sahgal V, Campbell JA, Hartz R, Shields TW. Fiber size and energy metabolites in five separate muscles from patients with chronic obstructive lung diseases. Respiration. 1983;44(5):321–8.

    Article  PubMed  CAS  Google Scholar 

  26. Ramachandran K, McCusker C, Connors M, Zuwallack R, Lahiri B. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD. Chron Respir Dis. 2008;5(4):205–9.

    Article  PubMed  CAS  Google Scholar 

  27. Bautista J, Ehsan M, Normandin E, Zuwallack R, Lahiri B. Physiologic responses during the six minute walk test in obese and non-obese COPD patients. Respir Med. 2011;105(8):1189–94.

    Article  PubMed  Google Scholar 

  28. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138(1):24–32.

    PubMed  Google Scholar 

  29. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.

    Article  PubMed  Google Scholar 

  30. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(6):1856–61.

    PubMed  CAS  Google Scholar 

  31. Wilson DO, Rogers RM, Wright EC, Anthonisen NR. Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. Am Rev Respir Dis. 1989;139(6):1435–8.

    PubMed  CAS  Google Scholar 

  32. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1791–7.

    PubMed  CAS  Google Scholar 

  33. Chailleux E, Laaban JP, Veale D. Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory. Chest. 2003;123(5):1460–6.

    Article  PubMed  Google Scholar 

  34. Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, et al. Risk factor paradox in wasting diseases. Curr Opin Clin Nutr Metab Care. 2007;10(4):433–42.

    Article  PubMed  Google Scholar 

  35. Casanova C, Cote C, de Torres JP, Aguirre-Jaime A, Marin JM, Pinto-Plata V, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(6):591–7.

    Article  PubMed  Google Scholar 

  36. Watson L, Vonk JM, Lofdahl CG, Pride NB, Pauwels RA, Laitinen LA, et al. Predictors of lung function and its decline in mild to moderate COPD in association with gender: results from the Euroscop study. Respir Med. 2006;100(4):746–53.

    Article  PubMed  CAS  Google Scholar 

  37. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82(1):53–9.

    PubMed  CAS  Google Scholar 

  38. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32(4):962–9.

    Article  PubMed  CAS  Google Scholar 

  39. Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010;65(11):956–62.

    Article  PubMed  Google Scholar 

  40. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.

    Article  PubMed  CAS  Google Scholar 

  41. Huang TT, Ball GD, Franks PW. Metabolic syndrome in youth: current issues and challenges. Appl Physiol Nutr Metab. 2007;32(1):13–22.

    Article  PubMed  CAS  Google Scholar 

  42. Fimognari FL, Pasqualetti P, Moro L, Franco A, Piccirillo G, Pastorelli R, et al. The association between metabolic syndrome and restrictive ventilatory dysfunction in older persons. J Gerontol A Biol Sci Med Sci. 2007;62(7):760–5.

    Article  PubMed  Google Scholar 

  43. Leone N, Courbon D, Thomas F, Bean K, Jego B, Leynaert B, et al. Lung function impairment and metabolic syndrome: the critical role of abdominal obesity. Am J Respir Crit Care Med. 2009;179(6):509–16.

    Article  PubMed  Google Scholar 

  44. Marquis K, Maltais F, Duguay V, Bezeau AM, LeBlanc P, Jobin J, et al. The metabolic syndrome in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2005;25(4):226–32. discussion 33–4.

    Article  PubMed  Google Scholar 

  45. Watz H, Waschki B, Kirsten A, Muller KC, Kretschmar G, Meyer T, et al. The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic inflammation and physical inactivity. Chest. 2009;136(4):1039–46.

    Article  PubMed  CAS  Google Scholar 

  46. Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89(6):2548–56.

    Article  PubMed  CAS  Google Scholar 

  47. Goossens GH. The role of adipose tissue dysfunction in the pathogenesis of obesity-related insulin resistance. Physiol Behav. 2007;94:206–18.

    Article  PubMed  Google Scholar 

  48. Fontana L, Eagon JC, Trujillo ME, Scherer PE, Klein S. Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes. 2007;56(4):1010–3.

    Article  PubMed  CAS  Google Scholar 

  49. Gan WQ, Man SF, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 2004;59(7):574–80.

    Article  PubMed  CAS  Google Scholar 

  50. Poulain M, Doucet M, Drapeau V, Fournier G, Tremblay A, Poirier P, et al. Metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2008;5(1):35–41.

    Article  PubMed  CAS  Google Scholar 

  51. Yasuda N, Gotoh K, Minatoguchi S, Asano K, Nishigaki K, Nomura M, et al. An increase of soluble Fas, an inhibitor of apoptosis, associated with progression of COPD. Respir Med. 1998;92(8):993–9.

    Article  PubMed  CAS  Google Scholar 

  52. Koehler F, Doehner W, Hoernig S, Witt C, Anker SD, John M. Anorexia in chronic obstructive pulmonary disease–association to cachexia and hormonal derangement. Int J Cardiol. 2007;119(1):83–9.

    Article  PubMed  Google Scholar 

  53. Vernooy JH, Kucukaycan M, Jacobs JA, Chavannes NH, Buurman WA, Dentener MA, et al. Local and systemic inflammation in patients with chronic obstructive pulmonary disease: soluble tumor necrosis factor receptors are increased in sputum. Am J Respir Crit Care Med. 2002;166(9):1218–24.

    Article  PubMed  Google Scholar 

  54. Petersen AM, Penkowa M, Iversen M, Frydelund-Larsen L, Andersen JL, Mortensen J, et al. Elevated levels of IL-18 in plasma and skeletal muscle in chronic obstructive pulmonary disease. Lung. 2007;185(3):161–71.

    Article  PubMed  CAS  Google Scholar 

  55. Donaldson GC, Seemungal TA, Patel IS, Bhowmik A, Wilkinson TM, Hurst JR, et al. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest. 2005;128(4):1995–2004.

    Article  PubMed  Google Scholar 

  56. Breyer MK, Spruit MA, Celis AP, Rutten EP, Janssen PP, Wouters EF. Highly elevated C-reactive protein levels in obese patients with COPD: a fat chance? Clin Nutr. 2009;28(6):642–7.

    Article  PubMed  CAS  Google Scholar 

  57. Rutten EP, Breyer MK, Spruit MA, Hofstra T, van Melick PP, Schols AM, et al. Abdominal fat mass contributes to the systemic inflammation in chronic obstructive pulmonary disease. Clin Nutr. 2010;29(6):756–60.

    Article  PubMed  Google Scholar 

  58. Skyba P, Ukropec J, Pobeha P, Ukropcova B, Joppa P, Kurdiova T, et al. Metabolic phenotype and adipose tissue inflammation in patients with chronic obstructive pulmonary disease. Mediators Inflamm. 2010;2010:173498.

    Article  PubMed  Google Scholar 

  59. Tkacova R, Ukropec J, Skyba P, Ukropcova B, Pobeha P, Kurdiova T, et al. Increased adipose tissue expression of proinflammatory CD40, MKK4 and JNK in patients with very severe chronic obstructive pulmonary disease. Respiration. 2010;81(5):386–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Program Development Center, Ciro+, Center of Expertise for Chronic Organ Failure, Hornerheide 1, 6085 NM, Horn, Limburg, The Netherlands

    Frits M. E. Franssen M.D., Ph.D.

  2. Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, Limburg, The Netherlands

    Emiel F. M. Wouters M.D., Ph.D.

Authors
  1. Frits M. E. Franssen M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emiel F. M. Wouters M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frits M. E. Franssen M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. , Pulmonary and Critical Care Medicine, University of Vermont College of Medicin, 89 Beaumont Ave., Burlington, 05405, Vermont, USA

    Anne E. Dixon

  2. , Clinical Development Medical Affairs, Respiratory Boehringer Ingelheim Pharmac, N/A, Ridgefield, 06877, Connecticut, USA

    Emmanuelle M. Clerisme-Beaty

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Franssen, F.M.E., Wouters, E.F.M. (2013). Obesity and Chronic Obstructive Pulmonary Disease. In: Dixon, A., Clerisme-Beaty, E. (eds) Obesity and Lung Disease. Respiratory Medicine, vol 19. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-053-3_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-053-3_8

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-052-6

  • Online ISBN: 978-1-62703-053-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation